Ann M. Connelly, MSN, RN, LSN, NCSN Public Health Nurse Supervisor School & Adolescent Health Ohio Department of Health

Full text

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Ann M. Connelly, MSN, RN, LSN, NCSN

Public Health Nurse Supervisor

School & Adolescent Health

Ohio Department of Health

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Learner Outcome: Nurses will be able to discuss

application of the nursing process to

address….Implementing School nursing

programs…..

Learning Objectives-Day One: The learner will

be able to:

4. Discuss considerations for implementing a school nurse program through a local health department.

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Overview

Assessment

Nursing Diagnosis

Goals

Planning

Implementation

Evaluation

Summary

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Nursing Process

Assessment Diagnosis Goals Planning Implementation Evaluation http://codes.ohio.gov/oac/4723-4-03

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1.

What kinds of schools are there?

2.

What are the health requirements for schools?

3.

Who else provides health services to schools?

4.

What is already being offered in your schools?

5.

What are the needs of the community?

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there

Public

• “Traditional” public schools

• Community “charter” schools

Nonpublic

• Chartered nonpublic

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School styles include

• City school districts

• Local school districts

• Exempted village school districts

• Cooperative education school districts

• Joint vocational school districts

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Community “Charter” Schools

Community “Charter” Schools must

• Meet all federal, state and local health and safety requirements

• Comply with federal and state audit requirements

• Comply with civil rights and disability education acts

• Be tuition-free and non-sectarian

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• “Nonpublic school that holds a valid charter issued by the state board of education”

• Must follow same operating standards as public

• Cannot charge tuition to students <200% FPL

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Sometimes referred to as “non-chartered, non-tax supported schools

(NCNT),” “non-chartered, nonpublic schools” or “-08 schools”

• Receive no revenue from any government entity

• Should be registered with ODE

• Requirements for number & length of school days and year, pupil attendance

• Requirements for curriculum, teacher qualifications, grade promotion procedure

• Required to comply with state and local health, fire and safety laws

• NOT entitled to pupil transportation, auxiliary services, administrative cost reimbursement

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What are the health requirements for

schools?

Immunization compliance monitoring

Vision and hearing screening

Provision of healthcare services that enable

students with special needs to stay in school

(federal)

Staff training (as needed) for medication

administration and diabetes care

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Screenings:

• BMI

• Postural (scoliosis)

• Blood pressure

• Diabetes

• Acanthosis Nigricans (Diabetes)

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Optional School Health Services

Health education and counseling

• Growth and development/puberty class; hygiene

• Nutrition and physical activity

• Smoking cessation

• Domestic violence, abuse, Harrassment-Intimidation-Bullying, human trafficking

• Reproductive health

• Referrals for healthcare or social services

• Information about head lice, bed bugs, MRSA and other communicable conditions

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More School Health Services

Staff education

• Medication administration • Diabetes care • CPR/AED/First Aid • Heimlich maneuver • Bloodborne pathogens • CERT

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Policy development

•School Wellness Committee/School Improvement Plan

•Food Allergy Policy guidance

•Emergency Preparedness Committee

•Recommendations for policies/procedures

•Epinephrine autoinjector policy/protocol

•Asthma inhaler policy/protocol

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Communication

• Develop Individualized Healthcare Plans (IHPs), Individualized Education Programs (IEPs) and 504 plans

• Emergency preparedness coordination with community partners

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• Local hospitals

• Educational Service Centers (ESCs)

• Private businesses

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• ESCs were created to support and improve school effectiveness and student achievement

• Services, including special education and related services, are provided to school districts, community schools and

chartered nonpublic schools

• ESCs are to reduce the unnecessary duplication of programs and services and provide for a more streamlined and efficient delivery of educational services without reducing the

availability of the services needed by school districts and schools

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• Some hospitals have established school health programs

• School and community nursing is much different from hospital nursing

• Some models provide one nurse for oversight at the hospital with health aides in the school

buildings

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• Some companies have established school health services

• Ohio-based companies

• Out of state/national companies

• May or may not understand school/community needs or culture or Ohio law

• Some models provide one nurse for oversight at the office with health aides in the school buildings

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What is already being offered

in your schools?

Ask schools in your area what health

services are being offered and by whom

• Be specific, as they may not recognize some activities as health services

• It may vary from building to building as well as district to district

• Much variance between public and non-public schools

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Every community is different

• You have already done a community health assessment

• What did you learn about services offered in your schools?

• Are there service needs you identified that

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Working in the schools will:

Improve the health of the community

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Schools reach the community The school community includes:

Students Staff

Parents and extended family

Schools are located in the communities you serve and

interacting with this community provides access to 60% of your community’s population

Working in the schools will

improve the health of the

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Why should health

departments work in

schools?

• Schools are a way to link students, staff and families to appropriate community resources and improve the health of the community

• Schools can be partners in surveillance,

immunizations, emergency preparedness and other public health activities

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Schools have assets that can extend your reach:

Buildings and grounds

Established communication systems Educated staff

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Working in the schools will help your health

department meet your goals

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• Environmental health services

• Communicable disease control, vaccination capacity, and quarantine authority

• Epidemiology services

• Health promotion and prevention (health education and policy, systems, and environmental change)

• Chronic disease prevention

• Emergency preparedness and response

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Clinical preventive and primary care services

• Immunizations

• Medical and dental clinics (primary care)

• Care coordination and navigation

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Community Health Assessment

Community Health Improvement Plan

LHD Strategic Plan

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What services do you want to offer?

How much do you want to charge for these services? How do you convince schools that you are a good

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offer

• Mandated tasks only?

• Training for school staff?

• Health education for classes?

• Development of IHPs or collaborate in the writing of IEPs/504 plans for CSHCN?

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How much do you want to charge for these

services?

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2012 ODH Survey

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How much do you want to

charge for the services?

By the hour?

• Example: you will provide a nurse in the elementary school building from 10-2 every school day

By the task?

• Example: you will review all immunization records

• Example: you will conduct all district vision and hearing screenings

• Example: you will conduct medication administration and bloodborne pathogen training for all staff

• Example: you will provide an RN to assess students and write IHPs for CSHCN in the high school

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How do you convince schools that you are a good

partner for them?

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Link your services to the school’s

achievement of their goals

(attendance, graduation rate, etc.)

Example: your timely, accurate review of

immunization records keeps students from being excluded and missing school

Example: your accurate vision & hearing screening, referral, linkage to community resources and follow up allows students to be academically successful

Example: your participation in the Emergency

Preparedness planning allowed students to safely evacuate the building during a flood

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Why are your services the best fit

for that school?

Example: While your services may be a little more expensive than some other options, your proposal is the best because you provide the schools with a licensed nurse who can assess and treat a student and return them to class, rather than a UAP who will send them home if they come to the clinic

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2012 ODH Survey

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As you are making plans to approach schools and provide health services to them, consider:

• Barriers

• Ways to overcome the barriers • Build in an evaluation plan

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Barriers cited for LHDs working effectively with schools: BARRIERS Funding Lack of LHD Staff Time

Competing Priorities in Schools Competing Priories in LHD

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Barriers cited for LHDs working effectively with schools: BARRIERS

Funding

Lack of LHD Staff Time

Competing Priorities in Schools Competing Priories in LHD

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Barriers cited for LHDs working effectively with schools:

BARRIERS

Funding

Lack of LHD Staff Time

Competing Priorities in Schools Competing Priories in LHD

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Barriers cited for LHDs working effectively with schools:

BARRIERS Funding

Lack of LHD Staff Time

Competing Priorities in Schools Competing Priories in LHD

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Barriers cited for LHDs working effectively with schools:

BARRIERS Funding Lack of LHD Staff

Time

Competing Priorities in Schools Competing Priories in LHD

Lack of School Interest Reframe LHD strategies to identify how work in schools can help LHD meet goals. Funding from contracts will help!

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Be sure to have a plan to collect data

throughout the school year to evaluate the plan

Include:

Quantitative Qualitative

National Association of School Nurses/

National Association of State School Nurse Consultants project

Step Up and Be Counted!

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• Provide the school services agreed upon

• Collect data for evaluation

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Was the school satisfied with your service? Did you meet your department goals?

Was this a cost-effective strategy?

Are there changes to the plan needed for the next school year?

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Collect qualitative data throughout the process

Are there testimonials to how your health services improved the ability of a student to be healthy and academically successful?

Do you have an organized method to survey

students, parents, staff about services offered and how they thought it went?

May be anecdotal, a thank you e-mail from a parent, etc.

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Many sources of quantitative data

Student absenteeism

Students receiving glasses, etc., due to community linkages

Number of students seen in the clinic Graduation rates

Number of staff trained EHR?

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Was there enough time in the building for your

staff to complete the work?

Did they identify more tasks that needed to be

done?

Were there any personnel issues such as

excessive absenteeism?

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What did you want to achieve by partnering

with the schools?

Did your immunization rates rise?

Did the school implement a campus wide tobacco free policy?

Did obesity rates decline due to your healthy diet and activity initiative?

Was there a decrease in bullying?

Was there improved referral for treatment for students with mental health issues?

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Were you over/under budget?

Should you increase/decrease price of services?

What was your return-on-investment?

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Example: When your nurse arrived at the school for screenings, was s/he stopped in the office to provide care to a student with diabetes?

Example: Was the number of students requiring IHPs lower than anticipated?

Example: Did your staff need to be available later in

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PHNs can use the Nursing Process to create a plan for school health services

Schools are nontraditional healthcare environments with different goals than healthcare providers

Health departments must develop plans for school

contracts that will provide benefit to both the schools and the health department

Remember to collect data along the way for evaluation!

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Thank you for your attention!

Ann M. Connelly, MSN, RN, LSN, NCSN Public Health Nurse Supervisor School Nursing & Asthma Programs

School & Adolescent Health Ohio Department of Health

246 N. High St., Columbus, OH 43215 614-728-0386

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• http://www.cdc.gov/nccdphp/dch/programs/CommunitiesPuttingPrevention toWork/ • http://www.nasbe.org/project/center-for-safe-and-healthy-schools/how-schools-work/ • http://www.phf.org/programs/publichealthworks/Pages/Public_Health_ Works.aspx • http://www.odh.ohio.gov • https://www.nasn.org/Research/StepUpBeCounted • http://Codes.ohio.gov • http://www.cdc.gov/healthcommunication/CDCynergy/Evaluation.html

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